Living Will and Advance Health-Care Instruction Requirements in Tennessee

At a glance

Tennessee separates an individual instruction from the more formal advance directive document. An adult may give the instruction orally or in writing. The instruction can name the condition that makes it operate. If the adult instead uses the written advance directive—often to combine instructions with an agent appointment—the signature, notary-or-witness, and attestation rules apply.

Requirements one by one

An instruction may be oral or written

Section 68-11-1803(a) permits an adult or emancipated minor to give an oral or written individual instruction and to limit it to a specified condition. The Act does not require an informal individual instruction to be signed, dated, witnessed, or notarized.

A formal advance directive is different. It must be written and signed by the principal. Tennessee's statute does not state a directed-signature or electronic-signature procedure. A copy has the same effect as the original under § 68-11-1813.

The formal document uses a notary or two witnesses

For a formal written advance directive, § 68-11-1803(b) allows notarization or two competent adult witnesses. The agent cannot witness. At least one witness must be unrelated by blood, marriage, or adoption and not entitled to inherit. The written directive also needs an attestation clause confirming the witness qualifications.

That means one witness may be related or able to inherit if the other satisfies both disinterested-witness conditions. An instruction given orally does not use this ceremony.

The adult chooses the condition

The Act does not require terminal illness, permanent unconsciousness, or another diagnosis for every instruction. Section 68-11-1803 lets the adult specify the condition. When a condition affects an instruction, the designated physician makes the determination under § 68-11-1803(d); § 68-11-1808 requires prompt charting and communication.

Incapacity is the default trigger for an appointed agent's authority. It is not an added prerequisite for every individual instruction.

Treatment choices are broad

The Act defines a health-care decision as consent, refusal, or withdrawal of consent to health care. Tennessee's optional form supplies separate choices for CPR, life support and other artificial support, treatment of new conditions, and tube feeding or IV fluids. It also frames those choices alongside comfort and pain management and permits added instructions.

Part 18 states no pregnancy-specific restriction. It separately provides that withholding or withdrawing care under the Act is not suicide, euthanasia, homicide, mercy killing, or assisted suicide.

Under § 68-11-1810, providers receive good-faith reliance protection; §§ 68-11-1812 to -1814 address capacity, copies, and the Act's legal-effect boundaries.

Treatment instructions have a form-light revocation rule

While having capacity, the adult may revoke the treatment-instruction portion at any time and in any manner communicating intent. A later conflicting directive revokes the earlier one only to the extent of the conflict. A copy of a written revocation has the same effect as the original.

The stricter signed-writing-or-personal-provider-notice rule in § 68-11-1804(a) applies to revoking an agent designation, not the adult's treatment instructions. Part 18 creates no state directive registry.

Refusal starts a notice-and-transfer process

Providers generally must comply with the adult's instruction or a reasonable interpretation of it. A provider may decline for conscience reasons. An institution may rely on a timely communicated conscience policy, and a provider or institution may decline medically inappropriate care or care contrary to generally accepted standards.

The objector promptly informs the patient and authorized decision-maker, continues care while transfer is pursued, and immediately makes reasonable transfer efforts unless assistance is refused. If transfer cannot be completed, the provider or institution is not compelled to comply.

What trips people up

• The formalities depend on the route. An oral individual instruction is not invalid merely because it lacks the two-witness or notary ceremony used for a formal written advance directive.
• The adult selects the medical trigger. The narrower conditions printed in the optional form are choices, not universal statutory prerequisites.
• Only one witness must be disinterested. The statute does not require both witnesses to be unrelated and unable to inherit.
• The interstate safe harbor is limited. Section 68-11-1803(h) applies when the directive was signed outside Tennessee by someone who was then a nonresident.

Common questions

Must a treatment instruction appoint an agent?

No. Section 68-11-1803(a) independently authorizes an oral or written individual instruction. The official form says its instruction and agent parts may be used together or independently.

Does Tennessee require a terminal diagnosis?

No universal diagnosis is required. The adult may make an instruction effective only if a chosen condition arises.

Can a provider refuse the instruction?

Yes, for the statutory conscience, institutional-policy, or medical-standard grounds. Section 68-11-1808 then requires notice, continuing care, and reasonable transfer efforts, but does not compel compliance if transfer cannot be effected.

Statutes and sources

• Tenn. Code §§ 68-11-1802 to -1804 — directive architecture, oral and written instructions, formal execution, conditions, interstate recognition, and revocation. Official enacted Act (accessed 2026-07-30).
• Tenn. Code §§ 68-11-1808 and -1810 to -1814 — provider compliance, objections, transfer, immunity, capacity, copies, and legal-effect boundaries. Official enacted Act (accessed 2026-07-30).
• 2014 Tenn. Pub. Ch. 676 — the only amendment shown in the current-code history for § 68-11-1803; it changes subsection (i)'s anti-conditioning rule, not the treatment-instruction dimensions above. Official public chapter (accessed 2026-07-30).
• Tennessee Advance Directive for Health Care — current optional combined form and its treatment, nutrition/hydration, comfort, and execution choices. Official state form (accessed 2026-07-30).